E Demirsoy1, M Unal, H Arbatli, N Yagan, F Tukenmez, B Sonmez. 1. Department of Cardiovascular Surgery, Istanbul Memorial Hospital, Istanbul, Turkey. ergundemirsoy@hotmail.com, edemirsoy@superonline.com
Abstract
AIM: Severely atherosclerotic (porcelain) ascending aorta is associated with increased morbidity and mortality during coronary artery bypass grafting (CABG) due to the increased risk of perioperative atheroembolism. Three maneuvers during CABG can cause atheromatous embolism from the diseased ascending aorta: 1) cannulation of the ascending aorta; 2) cross- clamping; 3) partial clamping for the construction of the proximal anastomosis. METHODS: In our hospital, extra-anatomic CABG was performed in 8 patients with heavily calcified ascending aorta: 6 patients were men and 2 women. Operations were performed on the beating heart in 5 patients, 2 patients operated on beating heart and another patient on fibrillating heart with supportive cardiopulmonary bypass (CPB). Arterial cannulation was done through the right femoral artery on these patients. Apart from internal mammary artery (IMA) grafts, proximal anastomotic sites were the right axillary, right subclavian and innominate arteries. RESULTS: One patient who preoperatively had dialysis dependent chronic renal failure, died as a result of dialysis complication on the 5th day. The postoperative course was uneventful in the other patients and no patient experienced either any cerebrovascular or visceral organ injury as a result of atheroemboli. CONCLUSION: We think that extra-anatomic CABG procedures are safe and reliable in patients with severely atherosclerotic (porcelain) ascending aorta to minimize the prevalence of perioperative stroke and systemic embolization.
AIM: Severely atherosclerotic (porcelain) ascending aorta is associated with increased morbidity and mortality during coronary artery bypass grafting (CABG) due to the increased risk of perioperative atheroembolism. Three maneuvers during CABG can cause atheromatous embolism from the diseased ascending aorta: 1) cannulation of the ascending aorta; 2) cross- clamping; 3) partial clamping for the construction of the proximal anastomosis. METHODS: In our hospital, extra-anatomic CABG was performed in 8 patients with heavily calcified ascending aorta: 6 patients were men and 2 women. Operations were performed on the beating heart in 5 patients, 2 patients operated on beating heart and another patient on fibrillating heart with supportive cardiopulmonary bypass (CPB). Arterial cannulation was done through the right femoral artery on these patients. Apart from internal mammary artery (IMA) grafts, proximal anastomotic sites were the right axillary, right subclavian and innominate arteries. RESULTS: One patient who preoperatively had dialysis dependent chronic renal failure, died as a result of dialysis complication on the 5th day. The postoperative course was uneventful in the other patients and no patient experienced either any cerebrovascular or visceral organ injury as a result of atheroemboli. CONCLUSION: We think that extra-anatomic CABG procedures are safe and reliable in patients with severely atherosclerotic (porcelain) ascending aorta to minimize the prevalence of perioperative stroke and systemic embolization.